Download Immigrants from the Former Soviet Union

Toward Middle East Cooperation
Drug Abuse and Infectious Disease
among
Former Soviet Union Immigrants
Richard Isralowitz, Ph.D.
Director
Alex Reznik, Ph.D.
Senior Research Associate
Regional Alcohol & Drug Abuse Resources Center
Ben Gurion University
USAID-MERC Program
Background
• Little is known about drug abuse among Former Soviet Union (FSU)
immigrants.
• The health needs of FSU immigrants are still in the early stage of
assessment.
• Among Russian speaking immigrants in Israel, there is a relatively
high level of poverty, especially among single parents and the
elderly who immigrated after 1989.
Background
(con’t)
• Since 1989, nearly 1 million people immigrated to Israel from the
FSU. Among the country's estimated 25,000-28,000 drug abusers,
about 25% are Russian-speaking.
• It appears that FSU immigrants have a high rate of drug abuse
compared to other immigrants and possibly even native born
populations
Research in Israel
FSU Drug Abusers in Treatment (152)
Background Characteristics
– Most were addicted (about 80%) before immigration.
– 44% reported a history of FSU imprisonment.
– 21% had been in a psychiatric hospital primarily for
detoxification.
– Physical abuse as a child was reported by 46% of the female
and 37% of the male drug abusers. Sexual abuse as a child was
reported by 36% of the women and 5% of the men.
– 50% said their family relationships had deteriorated since
immigration.
Sexual Abuse
(Lifetime)
Native Born & FSU Males
Native Born Male
FSU Male
Sexual abuse
No
Yes
Sexual Abuse
(Lifetime)
Native Born & FSU Females
Native Born Female
Sexual abuse
No
Yes
FSU Female
Research (con’t)
Alcohol Use
– Heavy alcohol use among parents was reported by 33% of the
male and 40% of the female FSU drug abusers.
– Drug use among parents was reported by 18% of the male and
38% of the female FSU drug abusers.
– Females had almost three times as many heavy alcohol using
mothers as did males (14% vs. 5%).
– Older drug abusers tend to be more heavy users of alcohol.
Family History: Alcohol Abuse
Native Born & FSU Males
Native Born Male
FSU Male
Alcohol abuse
in Family
No
Yes
Family History: Alcohol Abuse
Native Born & FSU Females
Native Born Female
Alcohol abuse
in Family
No
Yes
FSU Female
Family History: Drug Use
Native Born & FSU Males
FSU Male
Native Born Male
Drug use
in Family
No
Yes
(p≤.001)
Family History: Drug Use
Native Born & FSU Females
Native Born Female
FSU Female
Drug use
in Family
No
Yes
Research (con’t)
Treatment Factors
– Many drug abusers seek a medical fix for their addiction. It
appears that many tend to use treatment to reduce their level of
drug abuse, not to eliminate the problem.
– 44% of the those in drug treatment claimed to be "clean" of
heroin but using alcohol or other drugs such as amphetamines,
benzodiazepines, marijuana and hashish; only 17% reported to
be free of any licit or illicit substance use.
– 39% reported using heroin or opiate type drugs while in
treatment; the majority of this group (72%) were using such
substance(s) in combination with alcohol.
Drug/Alcohol Use
Native Born & FSU Males
Native Born Male
FSU Male
Drug Use
Monodrug
Polydrug (include alcohol)
Polydrug (exclude alcohol)
(p≤.01)
Drug/Alcohol Use
Native Born & FSU Females
Native Born Female
FSU Female
Drug Use
Monodrug
Polydrug (include alcohol)
Polydrug (exclude alcohol)
Route of Administration
Native Born & FSU Males
Native Born Male
FSU Male
Heroin:
Route of Administration
Noninjection
Injection
Heroin
(p≤.001)
Route of Administration
Native Born & FSU Females
Native Born Female
FSU Female
Heroin:
Route of Administration
Noninjection
Injection
Heroin
(p≤.001)
Route of Administration
Native Born & FSU Males
Native Born Male
FSU Male
Cocaine:
Route of Administration
Noninjection
Injection
Cocaine
(p≤.001)
Route of Administration
Native Born & FSU Females
Native Born Female
FSU Female
Cocaine:
Route of Administration
Noninjection
Injection
Cocaine
Research (con’t)
Female FSU (53) & Native–Born Drug Abusers (61)
– FSU female drug abusers tend to be better educated and have a
greater concern about their personal health and custody of their
children.
Research (con’t)
Other Factors - religion, acculturation, drug use
patterns, and work
– Religious affiliation (i.e., being Jewish) does not appear to
influence the attitudes and behavior of FSU drug abusers - a
comparison of 70 Jewish and 29 non-Jewish drug abusers
(Isralowitz, 2002).
– Acculturation does not appear to influence drug use attitudes
and behavior among FSU drug abusers. Numerous factors tend
to differentiate FSU and Israeli-born drug abusers including
patterns of injection heroin use; heroin use in combination with
other substances (e.g., alcohol), and work behavior- a
comparison of 114 FSU and 93 native-born Israeli drug users
(Isralowitz, 2004a).
Research (con’t)
– Current research shows younger FSU drug abusers are more
inclined to use heroin than older FSU drug abusers whose
problem behavior is mostly related to a combination of heroin
and alcohol (Isralowitz, et al., 2004b).
– Unlike native born Israeli drug abusers, those from the FSU tend
to be employed and less likely to have a family member who is
also using drugs (Isralowitz, et al., 2004b).
Research (con’t)
Infectious Diseases
HIV/HCV/TB rates among FSU male (269) and female
drug abusers (46) (Isralowitz, et al., 2004b).
FSU Males
HIV/AIDS*
Hepatitis C
Tuberculosis
5%
66%
4%
FSU Females
15%
72%
2%
* Most HIV infected FSU persons (about 80%) are younger than 30
years old compared with about 30% in the US (Field, 2004:118). In
Germany or the UK the number of newly identified IDU related HIV
infection was 2 persons per million inhabitants in 2002, the
corresponding figures were 129 in Russia and 94 in the Ukraine
(UNODC, 2004:85-86).
Research (con’t)
HIV/HCV/TB rates among FSU (269) and Israeli-born
(210) male drug abusers (46) (Isralowitz, et al., 2004b).
FSU Males
HIV/AIDS
Hepatitis C*
Tuberculosis
5%
66%
4%
Israeli-Born Males
<1%
35%
<1%
* In Europe including the FSU, it has been reported that depending on
location, between 40-90 percent of the IDU populations are HCV
infected (WHO, 2000).
Research (con’t)
HIV/HCV/TB rates among FSU (46) and Israeli-born (37)
female drug abusers (Isralowitz, et al., 2004b).
FSU Females
HIV/AIDS
Hepatitis C
Tuberculosis
15%
72%
2%
Israeli-Born Females
<1%
41%
<1%
Future Research Recommendations
– Regular monitoring (e.g., CEWG) of drug use and infectious
disease (i.e., HIV/AIDS, HCV and TB) is needed among high risk
populations including drug abusers and family members women and children.
– Research of drug treatment personnel is needed to understand
their knowledge about drug use and infectious disease (i.e.,
HIV/AIDS, HCV and TB). Such information should provide the
basis for content specific training that needs to be evaluated in
terms of its impact on treatment service provision and the
attitudes and behavior among high risk populations.
Recommendations (con’t)
– Research is needed about the obstacles encountered by FSU
immigrants that restrict access to treatment services.
– Information is needed to inform, not alarm, the FSU population
(and general population) about HCV and other infectious
diseases. Such information should be evaluated to determine its
impact on the attitudes and behavior among high risk
populations as well as its impact on service use.
Recommendations
(con’t)
– The issue of drug abuse and infectious disease (i.e., HIV, HCV
and TB) prevention should become a theme used to promote
communication and cooperation between Israel and its
neighbors in the Middle East region.
References
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Field, M. (2004). HIV and AIDS in the Former Soviet Bloc. New England Journal of Medicine 35,
1/2, July 8
Isralowitz, R. (2001). Toward an understanding of Russian speaking heroin addicts and
drug treatment services, Journal of Social Work Practice in the Addictions, 1(2), 33-44.
Isralowitz, R. (2002). Religious affiliation of Russian speaking heroin addicts in Israel,
Journal of Social Psychology, 142(6), 791-793.
Isralowitz, R., & Bar Hamburger, R. (2002a). Characteristics of heroin using immigrant
and native born women: Implications for policy and program development, Journal
of Psychoactive Drugs, 34(1), 97-103.
Isralowitz, R., & Borkin, S. (2002b). Russian-speaking immigrants: Factors associated with
heroin use. In Isralowitz, R. Afifi, M. & Rawson, R. (Eds.). Drug problems: Cross-cultural
policy and program development, 89-112. Westport, CT: Auburn House.
Isralowitz, R., Straussner, L., Vogt, I., & Chtenguelov, V. (2002c). Toward an understanding of
Russian speaking drug addicts in Israel, Germany and the United States, Journal of Social
Work Practice in the Addictions, 2(3/4), 119-136.
Isralowitz, R. (2003). Female heroin addicts in Israel. Psychiatric Times, Global Watch
Special Edition, XX, 11, 25-27.
References
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(con’t)
Isralowitz, R. (2004). Drug Use: A Resources Handbook, ABC-CLIO, Denver, Co.
Isralowitz, R. (2004a). Cultural identification and substance use: Immigrant and native heroin
addicts in Israel, Journal of Social Psychology, 144(2), 222-224.
Isralowitz, R., et al. (2005). Diseases and service utilization among Former Soviet Union
Immigrants: A view from New York City. Journal of Ethnicity in Substance Abuse,
forthcoming
United Nations Office on Drugs and Crime (2004). World Drug Report, Vol. 1: Analysis, Vienna.
World Health Organization, “Fact Sheet No. 164: Hepatitis C” (revised October 2000).
Thank you